******Due in 8-10 hours.

Discussion 1 (250-300 words, 2-3 credible references in APA)

“Democracies change their policies almost entirely through incremental adjustment. Policy does not move in leaps and bounds” thereby ensuring the stability of government (Miyakawa, 1999, p. 298).

In light of this classic quote, what incremental gains have been made by passage and implementation of the ACA, and what additional reforms will be necessary to move further toward health care access for all?

Reference: Miyakawa, T. (1999). The science of public policy: Essential readings in policy sciences I. New York: Taylor & Francis.

Discussion 2 (250-300 words, 2-3 credible references in APA)

Keeping in mind the case of the home health agency that we have discussed since Module 1. As Sara’s supervisor, how would you approach her case to ensure timely solution is implemented in regards to the concern of disease outbreak? What are the limitations of your approach?

Module 1 Case

Your supervisor told you that she recently received a call from an advocate whom an employee consulted via the Employee Assistance Program because the employee felt that she had been treated unfairly after contracting an illness. She explained that a few months ago, one of your agency’s home health aides, Sara, became ill. Sara had been coughing for approximately six weeks, lost weight without trying, had no appetite, was having difficulty sleeping, and had an intermittent fever. She became concerned and went to see a healthcare professional who diagnosed her with active tuberculosis (TB).

Sara missed a lot of time from work while completing treatment for TB. Her physician cleared her to return to work after she was no longer contagious. Upon returning to work, Sara felt isolated because her boss and co-workers refused to spend time with her. She heard that someone from the agency’s Human Resources Department told her co-workers her diagnosis. The stressful circumstances at work became even worse when another home health aide started to display the same symptoms Sara had.

Your supervisor has asked you to review the entire situation and how it was handled by the agency. Each module includes information about epidemiology, health statistics, public health, health communication and advocacy, health literacy, healthcare delivery systems, the Affordable Care Act, ethical considerations, human resources management, legal aspects, cultural and global perspectives, and financial considerations for the organization.

Your methodology over the next few weeks will be to arrange interviews with the relevant individuals, departments, and agencies, in addition to researching professional and scholarly sources, educational videos, and news articles. You will evaluate the information you gather throughout the course of your investigation in order to determine the best course of action. Ultimately, the information will be used to formulate policies and create an employee education presentation.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management

Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.

Education

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.

Research

1. Increase the integration of evidence-based care across the dimensions of end-of-life care.

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.

Administration

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.

4. Support the development and integration of palliative care services for all in- and outpatients and their families.

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

A description of your core values
A personal mission/vision statement
An analysis of your CliftonStrengths Assessment summarizing the results of your profile
A description of two key behaviors that you wish to strengthen
A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
Be sure to incorporate your colleagues’ feedback on your CliftonStrengths Assessment from this Module’s Discussion 2.

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?

To Prepare

Review Chapter 36 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.
Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.
Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.
Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.
Post an explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder. Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

Required Readings

**Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Chapter 35, “Structure and Function of the Digestive System”
This chapter provides information relating to the structure and function of the digestive system. It covers the gastrointestinal tract and accessory organs of digestion.

Chapter 36, “Alterations of Digestive Function”
This chapter presents information relating to disorders of the gastrointestinal tract and accessory organs of digestion. It also covers the pathogenesis, clinical manifestations, evaluation, and treatment of gastroesophageal reflux disease, gastritis, peptic ulcer disease, inflammatory bowel disease, and irritable bowel syndrome.

Chapter 37, “Alterations of Digestive Function in Children”
This chapter presents information relating to disorders of the gastrointestinal tract and liver that affect children. It focuses on congenital impairment, inflammatory disorders, metabolic disorders, as well as the impairment of digestion, absorption, and nutrition.

**Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

Chapter 13, “Gastrointestinal Disease”
This chapter provides a foundation for exploring gastrointestinal disorders by reviewing the structure and function of the GI tract. It also describes mechanisms of regulation of GI tract disorders such as acid-peptic disease, inflammatory bowel disease, and irritable bowel syndrome.

Chapter 14, “Liver Disease”
This chapter reviews the structure and function of the liver. It then explores the clinical presentation, etiology, pathogenesis, pathology, and clinical manifestations of three liver disorders: acute hepatitis, chronic hepatitis, and cirrhosis.

Chapter 15, “Disorders of the Exocrine Pancreas”
This chapter begins by reviewing the anatomy, histology, and physiology of the exocrine pancreas. It then examines the clinical presentation, etiology, pathology, pathogenesis, and clinical manifestations of acute and chronic pancreatitis, pancreatic insufficiency, and pancreatic cancer.

**de Bortoli, N., Martinucci, I., Bellini, M., Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013). Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World Journal of Gastroenterology, 19(35), 5787-5797. doi:10.3748/wjg.v19.i35.5787

– This work should have Introduction and Conclusion

– It should have at least 3 current references (Year 2013 and up)

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Student will develop a Legislative Matrix based upon the specific legislators in a residential/geographical legislative district. State and Federal legislators will be identified: State Representatives, Senators, Congressman and Governor. Each legislator’s assigned committees and any active legislation bills and/or past legislative initiatives will be identified. This information will be used to assist in the development of the Legislative Communication assignment.

• Please check rubric for detailed information see attachment

Submission Details:

• Support your responses with examples.
• Cite any sources in APA format.